Researchers offer general practice treatment and evaluation recommendations for kidney stones, based on a literature review reported in the March 3 issue of the BMJ.
"Urolithiasis affects 5-15% of the population worldwide," write Nicole L. Miller and James E. Lingeman, from Indiana University School of Medicine in Indianapolis. "Recurrence rates are close to 50%, and the cost of urolithiasis to individuals and society is high. Acute renal colic is a common presentation in general practice, so a basic understanding of its evaluation and treatment would be useful."
The authors conducted an evidence-based literature review of the management of urolithiasis, including Medline and the Cochrane Library. Although most studies were retrospective, they also cited prospective randomized controlled trials when available.
Based on this review, their summary conclusions were as follows:
For diagnosing urolithiasis, unenhanced helical computed tomography (CT) is the best radiographic technique.
Most ureteral calculi smaller than 5 mm in diameter will pass spontaneously within 4 weeks of symptom onset.
For treating urolithiasis, shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy have replaced open surgery.
Shock wave lithotripsy is effective in approximately 80% to 85% of simple renal calculi.
For complex renal calculi, percutaneous nephrolithotomy is the treatment of choice. Staghorn calculi should be treated, preferably with percutaneous nephrolithotomy in most patients.
For patients who are pregnant, morbidly obese, or have coagulopathy, ureteroscopy is the preferred treatment.
http://www.medscape.com/viewarticle/553460?src=mp
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